Trigeminal Neuralgia and Other Craniofacial Pain Syndromes: An Overview

Classic, idiopathic trigeminal neuralgia is an easily recognizable condition of excruciating, lancinating pain in one or more of the trigeminal distributions. Atypical features may exist (i.e., constant burning pains of a background nature) and we propose this condition represents the natural progression of trigeminal neuralgia type 1 to type 2. The etiology of trigeminal neuralgia is accepted as occurring from microvascular compression at the root entry zone, but other trigeminal facial pain syndromes exist and occur from iatrogenic (trigeminal deafferentation pain) or traumatic (trigeminal neuropathic pain) injuries. It is important to recognize when facial pain occurs in cranial nerve distributions other than the trigeminal nerve, as the treatments are different for geniculate, glossopharyngeal, and occipital neuralgia. Lastly, atypical facial pain occurs in a nonanatomic distribution and may be attributed to nonorganic or psychological causes. Pain from the facial sinuses, odontologic pain, and temporal mandibular joint pain are discussed.

KEYWORDS

Trigeminal neuralgia - craniofacial pain - neuropathic

REFERENCES

• 1 Brown J A, Coursaget C, Preul M C et al.. Mercury water and cauterizing stones: Nicolas Andre and tic douloureux.  J Neurosurg. 1999;  90 977-981
• 2 Jannetta P J. Treatment of trigeminal neuralgia by suboccipital and transtentorial cranial operations.  Clin Neurosurg. 1977;  24 538-549
• 3 Burchiel K J, Slavin K V. On the natural history of trigeminal neuralgia.  Neurosurgery. 2000;  46 152-155
• 4 Bullitt E, Tew J M, Boyd J. Intracranial tumors in patients with facial pain.  J Neurosurg. 1986;  64 865-871
• 5 Jensen T S, Rasmussen P, Riske-Nielson E. Association of trigeminal neuralgia with multiple sclerosis: clinical and pathologic features.  Acta Neurol Scand. 1982;  65 182-189
• 6 Iragui V J, Wiederholt W C, Romine J S. Evoked potentials in trigeminal neuralgia associated with multiple sclerosis.  Arch Neurol. 1986;  43 444-446
• 7 Golby A J, Norbash A, Silverberg G D. Trigeminal neuralgia resulting from infarction of the root entry zone of the trigeminal nerve: case report.  Neurosurgery. 1998;  43 620-623
• 8 Yonas H, Jannetta P J. Neurinoma of the trigeminal nerve and atypical trigeminal neuralgia: their commonality.  Neurosurgery. 1980;  6 273-277
• 9 Jannetta P J. Neurovascular compression in cranial nerve and systemic disease.  Ann Surg. 1980;  192 518-525
• 10 Jannetta P J. Microvascular decompression of the trigeminal nerve for tic douloureux. In: Youmans JR Neurological Surgery. 4th ed. Philadelphia; WB Saunders 1996: 3404-3415
• 11 Lee S H, Levy E I, Scarrow A M et al.. Recurrent trigeminal neuralgia attributable to veins after microvascular decompression.  Neurosurgery. 2000;  46 356-362
• 12 Haines S J, Jannetta P J, Zorub D S. Microvascular relations of the trigeminal nerve: anatomical study with clinical correlation.  J Neurosurg. 1980;  52 381-386
• 13 Hardy D G, Rhoton A L. Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve.  J Neurosurg. 1978;  49 669-678
• 14 Mehta L, Fatani J, Rao G. Superior cerebellar artery in the pontine zone.  Saudi Med J. 1981;  2 213-216
• 15 Beaver D L. Electron microscopy of the gasserian ganglion in trigeminal neuralgia.  J Neurosurg. 1967;  26 138-150
• 16 Kerr F WL, Miller R H. The pathology of trigeminal neuralgia electron microscopic studies.  Arch Neurol. 1966;  15 308-319
• 17 Kerr F WL. Pathology of trigeminal neuralgia: light and electron microscopic observations.  J Neurosurg. 1967;  26 151-156
• 18 Kunc Z, Fuchsova M, Novak M. Excision of the spinal trigeminal tract: electron microscopy.  Acta Neurochir (Wien). 1978;  41 233-241
• 19 Lazar M L, Kirkpatrick J B. Trigeminal neuralgia and multiple sclerosis: demonstration of the plaque in an operative case.  Neurosurgery. 1979;  5 711-717
• 20 Garcin R, Godlewski S, Lapresle J. Névralgie du trijumeau et sclerose en plaques.  Rev Neurol. 1960;  102 441-451
• 21 Gardner W J. Causation of trigeminal neuralgia. In: Hassler R, Walker AE Trigeminal Neuralgia: Pathogenesis and Pathophysiology. Philadelphia; WB Saunders 1970: 153
• 22 Eide P K, Rabben T. Trigeminal neuropathic pain: pathophysiological mechanisms examined by quantitative assessment of abnormal pain and sensory perception.  Neurosurgery. 1998;  43 1103-1110
• 23 Burchiel K J. Abnormal impulse generation in focally demyelinated trigeminal roots.  J Neurosurg. 1980;  53 674-683
• 24 Loeser J D, Calvin W H, Howe J F. Pathophysiology of trigeminal neuralgia.  Clin Neurosurg. 1977;  24 527-537
• 25 Baumann T K, Burchiel K J. A method for intraoperative microneurographic recording of unitary activity in the trigeminal ganglion of patients with trigeminal neuralgia.  J Neuroscience Methods. 2004;  132 19-24
• 26 Sist T, Filadora V, Miner M, Lema M. Gabapentin for idiopathic trigeminal neuralgia: report of two cases.  Neurology. 1997;  48 1467
• 27 Leandri M, Lundardi G, Inglese M et al.. Lamotrigine in trigeminal neuralgia secondary to multiple sclerosis.  J Neurol. 2000;  247 556-558
• 28 Zvartau-Hind M, Din M U, Gilani A et al.. Topiramate relieves refractory trigeminal neuralgia in MS patients.  Neurology. 2000;  55 1587-1588
• 29 Katusic S, Beard C M, Bergstralh E et al.. Incidence and clinical features of trigeminal neuralgia.  Ann Neurol. 1990;  27 89-95
• 30 Hartel F. Die leitungsanasthesie und injectionsbehandlung des ganglion gasseri und der trigeminusstame.  Arch Klin Chir. 1912;  100 193-292
• 31 Meglio M, Cioni B. Percutaneous procedures for trigeminal neuralgia: microcompression versus radiofrequency thermocoagulation.  Pain. 1989;  38 9-16
• 32 Skirving D J, Dan N G. A 20-year review of percutaneous balloon compression of the trigeminal ganglion.  J Neurosurg. 2001;  94 913-917
• 33 Moraci A, Buonaiuto C, Punzo A et al.. Trigeminal neuralgia treated by percutaneous thermocoagulation: comparative analysis of percutaneous thermocoagulation and other surgical procedures.  Neurochirurgia (Stuttg). 1992;  35 48-53
• 34 Sweet W H. Trigeminal neuralgia: problems as to cause and consequent conclusions regarding treatment. In: Wilkins, RH, Rengachary SS Neurosurgery. New York; McGraw-Hill 1985: 366-372
• 60 Burchiel K J, Steege T, Howe J et al.. Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureux.  Neurosurgery. 1981;  9 111-119
• 35 Piquer J, Joanes V, Roldan P et al.. Long term results of percutaneous gasserian ganglion lesions.  Acta Neurochir Suppl (Wien). 1987;  39 139-141
• 36 Puca A, Meglio M, Cioni B et al.. Intracerebral injury following thermocoagulation of the trigeminal ganglion.  Surg Neurol. 1992;  38 280-282
• 37 Brisman R. Gamma knife radiosurgery for primary management of trigeminal neuralgia.  J Neurosurg. 2000;  93(suppl 3) 159-161
• 38 Chang J W, Chang J H, Park Y G et al.. Gamma knife radiosurgery for idiopathic and secondary trigeminal neuralgia.  J Neurosurg. 2000;  93(suppl 3) 147-151
• 39 Lunsford D L. Radiosurgery for trigeminal neuralgia.  Surg Neurol. 2000;  54 285-287
• 40 Maesawa S, Salame C, Flickinger J C et al.. Clinical outcome after stereotactic radiosurgery for idiopathic trigeminal neuralgia.  J Neurosurg. 2001;  94 14-20
• 41 Sindou M, Fobe J, Ciriano D et al.. Hearing prognosis and intraoperative guidance of brainstem auditory evoked potential in microvascular decompression.  Laryngoscope. 1992;  102 678-682
• 42 Hasegawa T, Kondziolka D, Spiro R, Flickinger J C, Lunsford D. Repeat radiosurgery for refractory trigeminal neuralgia.  Neurosurgery. 2002;  50 494-500
• 43 Kondziolka D, Lunsford L D, Flickinger J C. Stereotactic radiosurgery for the treatment of trigeminal neuralgia.  Clin J Pain. 2002;  18 42-47
• 44 Pollock B E, Phuong L K, Gorman D A, Foote R L, Stafford S L. Stereotactic radiosurgery for idiopathic trigeminal neuralgia.  J Neurosurg. 2002;  97 347-353
• 45 Dandy W E. The treatment of trigeminal neuralgia by the cerebellar route.  Am J Surg. 1934;  24 447-455
• 46 Gardner W J, Miklos M V. Response of trigeminal neuralgia to decompression of sensory root: discussion of cause of trigeminal neuralgia.  JAMA. 1959;  170 1773-1776
• 47 Hamlyn P, King T. Neurovascular compression in trigeminal neuralgia.  J Neurosurg. 1992;  76 948-954
• 48 Jannetta P J. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia.  J Neurosurg. 1967;  26 159-162
• 49 Tashiro H, Kondo A, Aoyama I et al.. Trigeminal neuralgia caused by compression from arteries transfixing the nerve.  J Neurosurg. 1991;  75 783-786
• 50 Tsubaki S, Fukishima T, Tamagawa T et al.. Parapontine trigeminal cryptic angiomas presenting as trigeminal neuralgia.  J Neurosurg. 1989;  71 368-374
• 51 Barker F G, Jannetta P J, Bissonette D J et al.. The long term outcome of microvascular decompression for trigeminal neuralgia.  N Engl J Med. 1996;  334 1077-1083
• 52 McLaughlin M R, Jannetta P J, Clyde B L et al.. Microvascular decompression of cranial nerves: lessons learned after 4400 operations.  J Neurosurg. 1999;  90 1-8
• 53 Fraoli B, Esposito V, Guidetti B et al.. Treatment of trigeminal neuralgia by thermocoagulation, glycerolization, and percutaneous compression of the gasserian ganglion and/or retrogasserian rootlets: long term results and therapeutic protocol.  Neurosurgery. 1989;  24 239-245
• 54 Pollack I, Jannetta P J, Bissonette D. Bilateral trigeminal neuralgia: a 14 year experience with microvascular decompression.  J Neurosurg. 1988;  68 559-565
• 55 Sheldon C H, Pudenz R H, Freshwater D B. Compression rather than decompression for trigeminal neuralgia.  J Neurosurg. 1955;  12 123-126
• 56 Szapiro J Jr, Sindou M, Szapiro J. Prognostic factors in microvascular decompression for trigeminal neuralgia.  Neurosurgery. 1985;  17 920-929
• 57 Adams C BT. Microvascular compression: an alternative view and hypothesis.  J Neurosurg. 1989;  70 1-12
• 58 Morley T P. Case against microvascular decompression in the treatment of trigeminal neuralgia.  Arch Neurol. 1985;  42 801-802
• 59 Sweet W H, Wepsic J G. Controlled thermocoagulation of the trigeminal ganglion and rootlets for differential destruction of pain fibers: part I. Trigeminal neuralgia.  J Neurosurg. 1974;  40 143-156
• 61 Burchiel K J. Surgical treatment of trigeminal neuralgia: major operative procedures. In: Fromm G Medical and Surgical Management of Trigeminal Neuralgia. New York; Futura 1987: 101-119
• 62 Piatt J, Wilkins R H. Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships.  Neurosurgery. 1984;  14 462-471
• 63 Burchiel K J, Clarke H, Haglund M et al.. Long-term efficacy of microvascular decompression in trigeminal neuralgia.  J Neurosurg. 1988;  69 35-38
• 64 Hussein M, Wilson L, Illingworth R. Patterns of sensory loss following fractional posterior fossa Vth nerve section for trigeminal neuralgia.  J Neurol Neurosurg Psychiatry. 1982;  45 786-790
• 65 Lazorthes Y, Armengaud J P, DaMotta M. Chronic stimulation of the gasserian ganglion for treatment of atypical facial neuralgia.  Pacing Clin Electrophysiol. 1987;  10 257-265
• 66 Bullard D E, Nashold B S. The caudalis DREZ for facial pain.  Stereotact Funct Neurosurg. 1997;  68 168-174
• 67 Burchiel K J, Soldevilla F X, Loeser J D. Pathophysiology of atypical trigeminal neuralgia. In: Congress of Neurological Surgeons annual meeting, program abstracts 1991: 258
• 68 Goldstein N P, Gibilisco J A, Rushton J G. Trigeminal neuropathy and neuritis; a study of etiology with emphasis on dental causes.  JAMA. 1963;  184 458-462
• 69 Thrush D C, Small M. How benign a symptom is face numbness?.  Lancet. 1970;  2 851-853
• 70 Burchiel K J. Trigeminal neuropathic pain.  Acta Neurochir Suppl (Wien). 1993;  58 145-149
• 71 Sampson J H, Nashold B S. Facial pain due to vascular lesions of the brainstem relieved by dorsal root entry zone lesions in the nucleus caudalis.  J Neurosurg. 1992;  77 473-475
• 72 Hart R G, Easton J D. Trigeminal neuralgia and other facial pains.  Mo Med. 1981;  78 683-693
• 73 Rupa V, Saunders R L, Weider D. Geniculate neuralgia: the surgical management of primary otalgia.  J Neurosurg. 1991;  75 505-511
• 74 Young R F. Geniculate neuralgia [letter].  J Neurosurg. 1992;  76 888
• 75 Laha R K, Jannetta P J. Glossopharyngeal neuralgia.  J Neurosurg. 1977;  47 316-320
• 76 Ekbom K A, Westerberg C E. Carbamazepine in glossopharyngeal neuralgia.  Arch Neurol. 1966;  14 595-596
• 77 Sano K. Neurosurgical treatment of pain: a general survey.  Acta Neurochir Suppl (Wien). 1987;  38 86-96
• 78 Fraoli B, Esposito V, Ferrante L et al.. Microsurgical treatment of glossopharyngeal neuralgia: case reports.  Neurosurgery. 1989;  25 630-632
• 79 Arbit E, Krol G. Percutaneous radiofrequency neurolysis guided by computed tomography for the treatment of glossopharyngeal neuralgia.  Neurosurgery. 1991;  29 580-582
• 80 Rhoton A L, Oliveira E. Microsurgical anatomy of the region of the foramen magnum. In: Wilkins, RH, Rengachary, SS Neurosurgery Update I. New York; McGraw-Hill 1990: 434-460
• 81 Star M J, Curd J G, Thorne R P. Atlantoaxial lateral mass osteoarthritis: a frequently overlooked cause of severe occipitocervical pain.  Spine. 1992;  17 S71-S76
• 82 Ehni G, Benner B. Occipital neuralgia and the C1-2 arthrosis syndrome.  J Neurosurg. 1984;  61 961-965
• 83 Poletti C E, Sweet W H. Entrapment of the C2 root and ganglion by the atlanto-epistrophic ligament: clinical syndrome and surgical anatomy.  Neurosurgery. 1990;  27 288-291
• 84 Poletti C E. Proposed operation for occipital neuralgia: C2 and C3 root decompression.  Neurosurgery. 1983;  12 221-224
• 85 Hunter C R, Mayfield F H. Role of the upper cervical roots in the production of pain in the head.  Am J Surg. 1949;  78 743-751
• 86 Onofrio B M, Campa H K. Evaluation of rhizotomy: review of 12 years’ experience.  J Neurosurg. 1972;  36 751-755
• 87 White J C, Sweet W H. Pain and the Neurosurgeon. Springfield: Charles C Thomas 1969: 264-265
• 88 Bell C. Idea of a New Anatomy of the Brain. London; Strahan and Preston 1811: 17-19
• 89 Clifton G L, Vance W H, Applebaum M L et al.. Responses of unmyelinated afferents in the mammalian ventral root.  Brain Res. 1974;  82 163-167
• 90 Coggeshell R E, Ito H. Sensory fibers in ventral roots L7 and S1 in the cat.  J Physiol. 1977;  267 215-235
• 91 Coggeshell R E, Applebaum M L, Fazen M et al.. Unmyelinated axons in human ventral roots, a possible explanation for the failure of rhizotomy to relieve pain.  Brain. 1975;  98 157-166
• 92 Coggeshell R E, Coulter J D, Willis W D. Unmyelinated fibers in the ventral root.  J Cell Biol. 1972;  55 47A
• 93 Coggeshell R E. Afferent fibers in the ventral root.  Neurosurgery. 1979;  4 443-448
• 94 Blume H G. Radiofrequency denaturation in occipital pain: a new approach in 114 cases.  Adv Pain Res Ther. 1976;  1 691-698
• 95 Uematsu S. Percutaneous electrothermocoagulation of spinal nerve trunk, ganglion, and rootlets. In: Schmidek, HH, Sweet WH Operative Neurosurgical Techniques. New York; Grune & Stratton 1982: 1177-1198
• 96 Aubry M, Pialoux P. Sluder’s syndrome. In: Vinken, PJ, Bruyn GW Handbook of Clinical Neurology, Vol. 5. Amsterdam; Elsevier North Holland 1968: 350-361
• 97 Toussaint D. Raeder’s syndrome. In: Vinken, PJ, Bruyn GW Handbook of Clinical Neurology, Vol 5. Amsterdam; Elsevier North Holland 1968: 333-336
• 98 Rugh J D. Solberg WK. Psychological implications in temporomandibular pain and dysfunction.  Oral Sci Rev. 1976;  7 3-30
• 99 Laskin D, Block S. Diagnosis and treatment of myofascial pain-dysfunction (MPD) syndrome.  J Prosthet Dent. 1986;  56 75-84
• 100 Burgess J. Symptom characteristics in TMD patients reporting blunt trauma and/or whiplash injury.  J Craniomandib Disord. 1991;  5 251-257
• 101 Solberg W, Woo M, Houston J. Prevalence of mandibular dysfunction in young adults.  J Am Dent Assoc. 1979;  98 25-34